Pediatric Gastroenterology, Hepatology & Nutrition最新文献

Purpose: This study aimed to estimate the prevalence and predictors of portopulmonary hypertension (POPH) in children with portal hypertension.

Methods: We recruited children of both sexes aged 3-15 years with portal hypertension that was clinically suspected and confirmed by the presence of varices on esophagogastroduodenoscopy (EGD). The participants underwent clinical examination, 6-min walk distance (6-MWD), and echocardiography.

Results: We enrolled 94 children with portal hypertension: 26.6% with pre-hepatic causes and 73.4% secondary to chronic liver disease. Among our participants, 13.8% had one or more cardiac manifestations, such as exercise intolerance, dyspnea on exertion, cyanosis, or orthopnea, whereas 86.2% were asymptomatic. EGD examination revealed grade I varices in 54.3% of cases, grade II-III in 43.6%, and grade IV in 2.1%. Pulmonary hypertension (>35 mmHg) was detected in 30.9% of cases using echocardiography; two of them were >45 mmHg. Patients with POPH had significantly more frequent dyspnea on exertion, lower O₂ saturation, and more severe variceal grades than those with normal pulmonary artery pressure. Five (6.9%) cases had <300 m 6-MWD, with no significant difference between patients with normal and those with elevated pulmonary artery pressure. The duration of portal hypertension and 6-MWD were correlated significantly with the echocardiographic measures. High-grade varices (p=0.04) and low O₂ saturation (p=0.03) were identified as risk factors for POPH.

Conclusion: POPH was detected in 30.9% of our study group. High-grade varices and low O₂ saturation are predictors of POPH. Echocardiography screening is crucial for the early detection of cases.

The use of abdominal ultrasound is becoming a necessity, rather than an option, for pediatricians. Incorporating abdominal ultrasound training into resident training programs for pediatricians provides a direct pathway for physicians to effectively utilize point-of-care ultrasound (POCUS) in their clinical practice after board certification. This study proposed a detailed system to support this initiative by establishing 22 standard views of pediatric abdominal ultrasound and emphasizing a structured training regimen with repeated practice to achieve proficiency. This approach offers a streamlined method for trainees to become experts rapidly. After board certification, this foundational training serves as the basis for advanced learning, allowing clinicians to tailor POCUS techniques according to their specific areas of practice.

Purpose: This study aimed to evaluate the efficacy of oil massage as an adjunct therapy for neonatal jaundice during phototherapy.

Methods: A total of 160 neonates with unconjugated hyperbilirubinemia were enrolled and randomly allocated into two study groups using a computer-generated random number table. Group 1 (Intervention Group) consisted of 84 patients who received both phototherapy and massage therapy, while Group 2 (Control Group) consisted of 76 patients who received only phototherapy. The intervention group underwent massage therapy three times daily for 20 minutes over two consecutive days. Transcutaneous bilirubin levels were measured every eight hours. Additionally, the total duration of phototherapy and the 24-hour stool and urine output frequency were recorded in both groups.

Results: There were no significant differences in the demographic characteristics between the two groups. However, stool frequency and urine output were significantly higher in the intervention group. The average duration of phototherapy was 19.4±4.17 hours in the intervention group compared to 28.4±6.58 hours in the control group (p<0.001). The rate of Transcutaneous bilirubin reduction was significantly higher in the intervention group during the first 24 hours. A rebound increase in bilirubin levels was observed at 40 and 48 hours in both groups after phototherapy was discontinued.

Conclusion: Phototherapy combined with massage significantly reduced total bilirubin levels in newborns with neonatal hyperbilirubinemia, making it a valuable adjunct treatment for the rapid reduction of bilirubin in neonates.

Purpose: Pediatric gastrointestinal (GI) endoscopy significantly contributes to the diagnosis and management of GI diseases in children. Global data on pediatric GI endoscopy in the Asia-Pacific region are limited. We aimed to report the findings of a regional survey on pediatric endoscopy in the Asia-Pacific region.

Methods: A questionnaire-based survey involving GI endoscopy centers in 13 Asia-Pacific countries (June to November 2021). The questionnaires included annual procedure volumes (from basic diagnostics to advanced therapeutic endoscopy), endoscopists, sedation procedures, and national training programs.

Results: A total of 162 GI endoscopy centers completed the survey. All centers performed basic endoscopies (esophagogastroduodenoscopy and ileocolonoscopy); however, 45.1% and 59.1% of the centers performed less than 50 esophagogastroduodenoscopies and ileocolonoscopies per year, respectively. Small bowel evaluation (capsule endoscopy or balloon-assisted enteroscopy) was performed in 59.3% of the centers. Foreign body removal, polypectomy, and percutaneous endoscopic gastrostomy were performed in 89.5%, 85.8%, and 52.5% of centers, respectively. Endoscopic hemostatic interventions, which are life-saving procedures, included glue injection (30.9%), hemostasis of nonvariceal bleeding (65.4%), and endoscopic variceal ligation (70.4%). Pediatric GI endoscopy is performed not only by pediatric gastroenterologists but also by adult gastroenterologists in 21-50% of centers for many kinds of procedures. Sedation was provided by anesthesiologists in 65.4% of the centers. Most centers offer both adult and pediatric endoscopy training.

Conclusion: The study highlights regional disparities in pediatric GI endoscopy services. It emphasizes the need for expanded pediatric GI training and improved access to therapeutic endoscopy, particularly for life-saving procedures.

Purpose: Cholestatic complications remain a primary cause of post-liver transplantation (LTX) morbidity in pediatric patients. Standard biliary access by endoscopic retrograde cholangioscopy may not be feasible due to modified biliary drainage. Percutaneous transhepatic biliary drainage (PTCD) may be performed alternatively. However, systematic data concerning safety and efficacy of PTCD in these patients are scarce.

Methods: In this retrospective study, procedural and safety characteristics of PTCD in pediatric patients following LTX were analyzed. We compared laboratory indicators of inflammation, cholestasis, and graft function before and at 6 and 12 months after the first PTCD insertion. Efficacy was analyzed by percentage of patients without cholangitis, need for surgical biliary re-intervention and re-transplantation during a follow-up period of 60 months.

Results: Over a decade, PTCD was attempted in a total of 15 patients, with technical success (93.3%) in 14 patients. Periprocedural complications, including bleeding (7.1%) and cholangitis (21.4%) were observed in patients. During follow-up, both MELD-score (baseline: 13 [8-15] vs. 12 months: 8 [7-8], p<0.001) and parameters of cholestasis (GGT: baseline: 286 [47-458] U/L vs. 12 months: 105 [26-147] U/L, p=0.024) decreased. Prior to PTCD, cholangitis (64.3%) and cholangiosepsis (21.4%) were common complications. In contrast, following PTCD, cholangitis occurred in only one patient (7.1%). Five patients (35.7%) needed surgical biliary re-intervention and two (14.3%) required re-transplantation.

Conclusion: PTCD in pediatric patients following LTX had an acceptable safety profile, demonstrating a biochemical improvement of both cholestasis and graft function and may prevent cholestatic complications, thus reducing the need for surgical re-intervention and re-transplantation.

Purpose: The Cow's Milk-related Symptom Score (CoMiSS) improves the recognition of cow milk allergy (CMA) symptoms. A score of ≥10 should raise awareness of CMA. The median CoMiSS in healthy European infants aged <6 months is 3. This study aimed to determine the impact of different regions on CoMiSS in healthy infants aged <12 months to evaluate regional and age-related differences.

Methods: A prospective cross-sectional study was conducted at one hospital each in Indonesia (Jakarta) and Brazil (Sergipe). CoMiSS was assessed in healthy infants aged -12 months old.

Results: In Jakarta, a total of 286 infants (50.7% boys) were included. The median (interquartile range) CoMiSS was 1.5 (0-4); the 95th percentile was 7. In Sergipe, 101 infants (60.4% boys) were included. The median (interquartile range) CoMiSS was 4 (4-6); the 95th centile was 10.9. Age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94-0.99; p<0.001) and country (OR, 2.40; 95% CI, 2.06-2.79; p<0.001) were significant independent predictors of changes in mean CoMiSS in a linear regression model (r²=0.27).

Conclusion: Median CoMiSS in healthy infants differed between Jakarta and Sergipe (1.5 vs. 4.0). These findings highlight that the perceived normality of parents may be region-dependent.

Purpose: Gastrostomy granulomas frequently occur in pediatric patients with gastrostomy tubes, yet there is a notable lack of comprehensive data on the efficacy and safety of various treatment modalities. Commonly used treatments, such as silver nitrate, are often painful and require frequent clinic visits, posing challenges for patients and families. Additionally, research on home-based treatments is limited, despite their potential to offer more convenient and less painful alternatives. This study addresses the need for well-designed comparisons of different treatment options.

Methods: We conducted a prospective, open-label study at the Children's Hospital of San Antonio, enrolling 36 pediatric patients aged 6 months to 17 years with gastrostomy tubes. Patients were randomized into two groups: one treated with topical silver nitrate and the other with table salt, excluding those on chemotherapy or with immunologic disorders. Granuloma sizes were measured at the study's start with blinded physicians analyzing photographs to assess size reduction, and parent satisfaction surveys were conducted to evaluate treatment acceptability and side effects.

Results: The median reduction in granuloma size was significantly greater in the table salt group (3.12 mm) compared to the silver nitrate group (2.25 mm) (Wilcoxon p-value=0.04). Parental satisfaction and confidence were high in both groups, with minor, self-limited skin irritation reported as a side effect.

Conclusion: The study suggests that table salt could be a feasible, non-inferior, and cost-effective alternative to silver nitrate for treating gastrostomy granulomas in pediatric patients. Further research with a larger sample size is necessary to validate these findings.

The magnitude of the problem of stunting is high in low- to middle-income countries, including Indonesia. The government of Indonesia has implemented specific and sensitive intervention programs to reduce this problem. This public health problem requires multidisciplinary management with suitable approaches and programs. In the first 1000 days of life, the quality of life is determined by conception and delivery until two years old. The requirement and fulfillment of nutrients during this period would benefit the growth and development of children. Indonesia is an archipelago country with 100,000 km of coastline and 16,771 islands with great potential for fishing. In coastal areas, optimizing protein consumption from the sea and enhancing educational programs in psychosocial care are appropriate intervention programs that will benefit stunting eradication. The complexity of the stunting problem puts authorities and other stakeholders together to formulate and design appropriate comprehensive intervention programs to improve the quality of life of the next generation.

Purpose: Eosinophilic esophagitis (EoE) is the most well-known eosinophilic gastrointestinal disorder (EGID) characterized by the presence of a high number eosinophils within the esophageal epithelium and the clinical signs. Biopsies of patients with suspected EoE may not show a high number of eosinophils, however the presence of granules may help with the diagnosis. This study aims to evaluate the presence of cell-free eosinophil granules in the esophageal tissue of patients with suspected and confirmed EoE to accelerate the diagnosis and treatment of patients with low eosinophil count.

Methods: Fifteen patients with confirmed EoE and 15 suspected of EoE were included in this study. Patients' esophageal tissue biopsies were stained using immunohistochemistry (IHC) to identify eosinophils and their cell-free granules. For testing, anti-major basic protein (MBP) and anti-chemokine receptor type 3 (CCR3) were used as primary antibodies and a double-staining kit containing secondary antibodies conjugated to the enzyme and related chromogens were used.

Results: Cell-free granules with different degrees were observed in 53.3% and 93.3% of suspected and confirmed EoE samples, respectively. Furthermore, in esophageal biopsy of 73.3% of patients with suspected and 93.3% of patients with a definitive diagnosis of EoE, basal layer hyperplasia (BLH) was recognized.

Conclusion: The results of the present study showed that IHC can be applied to detect cell-free eosinophil granules in esophageal tissue. Observation of granules and basal cell hyperplasia in biopsies of suspected EoE patients whose eosinophil count is below the threshold can be valuable findings to make a definitive diagnosis for these patients.

Purpose: We aimed to evaluate the association between platelet count and endoscopy activity in pediatric patients with Crohn's disease (CD).

Methods: This single center retrospective study included children and adolescents aged <19 years who were newly diagnosed with CD. Comparison of baseline characteristics at diagnosis between two groups divided according to the presence and absence of thrombocytosis were conducted. Factors associated with moderate-to-severe endoscopic activity was also conducted.

Results: A total of 50 were included. Thirty-five patients (70.0%) were male, and the mean age±standard deviation was 13.7±2.5 years. Among patients without thrombocytosis, endoscopic activity was mild in 9 patients (42.9%), moderate in 11 (52.4%), and severe in 1 (4.8%), while among patients with thrombocytosis, endoscopic activity was mild in 3 (10.3%), moderate in14 (48.3%), and severe in 12 (41.4%) (p=0.003). According to multivariate analysis with stepwise selection, platelet count (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.00-1.02; p=0.021) and albumin (OR, 0.15; 95% CI, 0.02-0.98; p=0.045) were significantly associated with moderate-to-severe endoscopic activity at diagnosis. According to the receiver operating characteristic (ROC) curve analysis, the optimal platelet count cut-off level associated with moderate-to-severe endoscopic activity was 456,000/µL with an area under the ROC curve of 0.752 (95% CI, 0.598-0.906; sensitivity, 55.3%; specificity, 91.7%; postitive predictive value, 95.5%; negative predictive value, 39.3%; p<0.001).

Conclusion: Pediatric patients with CD that present with thrombocytosis at diagnosis are likely to have a moderate-to-severe endoscopic activity.